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Prevention

Although there is no fixed way to prevent pre-eclampsia, there are some measures which can be taken to reducing the risk of this condition

This includes:

Being healthy prior to conceiving (this can also help minimise the risk of other pregnancy complications!
Managing pre-existing medical conditions if any
- Do consult with your doctor in relation to this to best manage the conditions and have a healthy pregnancy
Work towards maintaining a healthy body weight, a BMI between 19-25 is quite safe for women looking to have children.
Avoid unnecessary stress
- Unnecessary stress can lead to increased blood pressure
Having a healthy diet
- This includes eating balanced meals, such as more fruits and vegetables, while avoiding foods high in saturated fats and sodium.
- You may also consider increasing calcium intake if one has low calcium intake but at risk of pre-eclampsia
Avoid alcohol and cigarettes
- Especially for pregnant women, consumption of alcohol and smoking can lead to many negative side effects, which include increased blood pressure.
Exercise regularly (150 minutes per week of moderate intensity exercise is good!)
Going for routine checkups with obstetrician
- It would be good to go for routine checkups with your doctor, and perform health screenings for suspected conditions.
- You can not only reduce the risk for developing such conditions, treatment may also be more successful.

Additionally, low dose aspirin is recommended for women at high risk (i.e. pre-existing hypertension, pre-eclampsia in previous pregnancies)

This can start after 1st trimester (14 weeks)
Lower risk of hypertension during pregnancy and development of pre-eclampsia

Routine Pregnancy Screening

What happens at the antenatal visits?

If you have been diagnosed with pre-eclampsia, it is important to go for antenatal visits 1-2x per week to follow up and monitor your condition! Your doctor may also perform some tests during these checkups, which can include:

Tests to see if the condition is progressing
- Blood test: this can be used to assess kidney and liver function
- Urine test: urinary protein levels can also reflect how pre-eclampsia is progressing
Tests to monitor growth of fetus
- Ultrasound: an ultrasound can be used to check blood flow to the fetus, monitor its growth, and assess amniotic fluid^[1].
- Cardiotocography: this is a method to electronically monitor the heart rate of the fetus, and can be used to detect signs of distress.

What can I do at home?

In cases of less severe pre-eclampsia, it can be managed on an outpatient basis, so it would be good to take these measures by yourself at home!

Daily blood pressure monitoring
- Using a blood pressure monitor, you can take your blood pressure to check for abnormal levels as this could mean the condition has worsened.
Keep track of baby’s kick count
- Keeping track of your baby’s kick count can help you monitor its movement and health to some extent.

Treatment Options

How can pre-eclampsia be treated? The treatment for each patient depends greatly on the severity of pre-eclampsia, and the stage of pregnancy which one is at.

Lifestyle

For patients with pre-eclampsia that is mild,

More bedrest, less physical activity to reduce blood pressure
Close monitoring by doctor or midwife

Admission for inpatient monitoring will be considered if:

Severe pre-eclampsia
Persistent hypertension or proteinuria

Diet

While diet is not a sure way of treating pre-eclampsia, there are changes which can be made to one’s diet to avoid progression of the condition. This include:

Having a low – moderate sodium content in food
Increased protein consumption (pre-eclampsia involves proteinuria^[2])
For severe cases,
- Dietary changes during hospital stay can also include electrolyte and fluid replacements

Medications

Antihypertensive medication (to control blood pressure)

Recommended when diastolic blood pressure above 100mmHg, and proteinuric gestational hypertension
First-line choices include: methyldopa, labetalol, nifedipine

Steroid medications — corticosteroids

Considered if patient has severe pre-eclampsia
As baby may be delivered prematurely, this can help the baby’s lungs mature
Temporarily improves platelet and liver function of the mother

Magnesium sulfate — anticonvulsant (to prevent seizures)

Recommended for women with pre-eclampsia that are at risk of seizure
Also given if patient has a plan for delivery
Delivered to patient’s bloodstream intravenously (IV)

Delivery

Delivery is the only actual cure for pre-eclampsia.

If pre-eclampsia is discovered at 37 weeks or after, the patient will be asked to deliver immediately if possible. This is because the baby would be fully mature by that time.
- This can be done through caesarean section or induced labour.
Delivery at 37 weeks would also be recommended for patients with mild pre-eclampsia that is discovered earlier.
- If the baby is not doing well in the womb, it may also be advised to deliver earlier.
However, if the patient has severe pre-eclampsia, delivery would be carried out as soon as possible past the 34 week mark.
- Usually delivered via caesarean section
- Baby may need to stay in NICU

Other factors which contribute to consideration of delivery:

Evidence of fetal compromise (would be noticed from monitoring of baby)
Problems with controlling blood pressure
High risk of eclampsia, or eclampsia
Evidence of severe organ dysfunction or multi-organ dysfunction in mother
Clinician is confident of fetal maturity

Close follow-up (after giving birth)

After delivery of your child, pre-eclampsia will usually go away in a time span between a few hours to 6 months. However, follow-up is important as pre-eclampsia is a condition which can escalate quickly and have severe effects if not monitored.

Monitoring of blood pressure right after delivery
- There is possibility that the mother’s condition deteriorates so must establish that blood pressure has stabilised
- Must continue to check blood pressure regularly even after leaving the hospital, medication may also continue depending on the patient.
May be at higher risk of cardiovascular disease in the future

Postpartum Pre-Eclampsia

In some cases, patients may only experience pre-eclampsia after delivery, and it is important to get treatment as soon as possible. This condition usually occurs between 48 hours to 6 weeks after delivery.

Common symptoms of postpartum pre-eclampsia include:
- Headaches and nausea
- Vision changes
- Abdominal pain

Pre-eclampsia can be a serious complication during pregnancy, but it is also one that can be managed with the help of a medical team. If you are pregnant or know someone who is, make sure to educate yourself on the signs and symptoms of pre-eclampsia so that you can seek treatment as soon as possible if necessary.